Poor Children Show a Decline in Obesity Rate

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In Baltimore, a class of 5-year-olds at Union Baptist Harvey Johnson Head Start jump during a motion break. Union Baptist makes a point of promoting health.CreditCreditJessica Kourkounis for The New York Times

After years of growing concern about obesity among children, federal researchers have found the clearest evidence yet that the epidemic may be turning a corner in young children from low-income families.

The obesity rate among preschool-age children from poor families fell in 19 states and United States territories between 2008 and 2011, federal health officials said Tuesday — the first time a major government report has shown a consistent pattern of decline for low-income children after decades of rising rates.

Children from poor families have had some of the nation’s highest rates of obesity. One in eight preschoolers in the United States is obese. Among low-income children, it is one in seven. The rate is much higher for blacks (one in five) and for Hispanics (one in six).

Several cities have reported modest drops among school-age children, offering hints of a change in course. But gains were concentrated among whites and children from middle- and upper-income families, and were not consistent across the country.

“We’ve seen isolated reports in the past that have had encouraging trends, but this is the first report to show declining rates of obesity in our youngest children,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, which prepared the report. “We are going in the right direction for the first time in a generation.”

The cause of the decline remains a mystery, but researchers offered theories, like an increase in breast-feeding, a drop in calories from sugary drinks, and changes in the food offered in federal nutrition programs for women and children. In interviews, parents suggested that they have become more educated in recent years, and so are more aware of their families’ eating habits and of the health problems that can come with being overweight.

Health officials noted a small decline in the national rate for low-income children for the first time in December, but they did not regard it as important because they lacked a geographic breakdown to show whether the pattern had taken hold in many states.

The new report, based on the country’s largest set of health data for children, used weight and height measurements from 12 million children ages 2 to 4 who participate in federally funded nutrition programs, to provide the most detailed picture of obesity among low-income Americans.

It included data from 40 states, as well as the District of Columbia, Puerto Rico and the United States Virgin Islands. Ten states were not included because of incomplete data. Trained health professionals took the children’s measurements.

“This is the first time we have this many states in the U.S. showing a decline,” said Heidi Blanck, a senior researcher at the C.D.C. “Until now, it has been a patchwork.”

Researchers last analyzed these data in 2009, when only 9 states and territories had obesity declines and 24 had increases. In the report on Tuesday, the proportions were reversed, with only 3 states experiencing increases and 18 states and the Virgin Islands showing declines; 19 states, the District of Columbia and Puerto Rico were flat. The declines were modest: Most states dropped by less than 1 percentage point.

More children were added to the study because of a drop in their income during the economic downturn, leading researchers to investigate whether the decline could be attributed to an influx of new children with lower weights. They concluded that it was not, Dr. Blanck said.

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Students at Union Baptist get health lessons, field trips to a grocery store, healthier meals and an hour of exercise a day.CreditJessica Kourkounis for The New York Times

Researchers agreed that the decline was real and held good implications for future health in America. Children who are overweight or obese between age 3 and 5 are five times as likely to be overweight or obese as adults, creating a higher risk of heart disease, stroke, diabetes and cancer.

But there was little consensus on why the decline might be happening.

Children now consume fewer calories from sugary beverages than they did in 1999, Dr. Blanck said. More women are breast-feeding, which can lead to healthier weight gain for young children. Federal researchers have also chronicled a drop in overall calories for children in the past decade, down by 7 percent for boys and 4 percent for girls, but health experts said those declines were too small to make much difference.

Many scientists doubt that anti-obesity programs actually work, but proponents of the programs say a broad set of policies applied systematically over a period of time can affect behavior.

“We can’t prove what are the changes in environment and policy that led to” the declining rates, Dr. Frieden said. But he added that it was hard to believe that the government policies now in place “aren’t having a big role here.”

Tom Baranowski, a professor of pediatrics at Baylor College of Medicine who has been skeptical about government interventions, said obesity has as much to do with genes as it does with behavior. “It could be that we are hitting some sort of a biological limit,” he said, in which “all those who are genetically predisposed to being obese already are.”

At the Union Baptist Harvey Johnson Head Start, a bright preschool in Baltimore, the focus is on behavior. Children now get health lessons, field trips to a grocery store, healthier meals and an hour of exercise a day on a new jungle gym. Instructors measure children’s height and weight and a nutritionist counsels parents. The income threshold for a family of three is under $20,000.

The share of the school’s approximately 250 children who were obese or overweight fell to 33 percent in 2013, from 35 percent in 2010.

In interviews, parents agreed that encouragement from child care programs like Union Baptist, as well as warnings from doctors, had helped. But just as important, they said, were health worries that have taken hold in low-income communities because of the epidemics of obesity and diabetes.

Shannon Freeland, a 35-year-old pharmacy tech instructor, said both her grandmothers died in their 50s. One, who weighed 300 pounds, had a heart attack, while the other died from diabetes after amputations that began with her toes and ultimately took both legs.

“Grandparents aren’t supposed to pass like that,” said Ms. Freeland, whose first child, Iren, was overweight as a toddler. “That’s when it started to click for me.”

She added, “We were pricking Iren’s finger at age 2, and that was scary for me.”

Ms. Freeland said it was still hard to eat better, partly because it is expensive, but also because with three children, the pull of fast food is strong. She has tried shopping at Whole Foods, but said she cannot afford it. But since going back to college for a degree in public health, she has become more aware of her family’s food habits. Many of her friends are also back in school, avoiding a grim job market.

“People look at Head Start moms and say, ‘Oh they’re just low income and that’s it,’ ” she said. “I think parents have changed. Our income may still be low, but we’re more educated.”

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